Southeastern Louisiana University

Summer 2012 Registration

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Summer 2012 Registration

Fields marked with an * are required.

Student Information

- Student's Name: *
- Age: *
- School: *
- Address: *
- City: *
- Zip: *
- Email: *
- Parent's Name: *
- Phone(home): *
- Phone(work):
- Phone(cell):
- Instrument: *
- Other Instrument:
- Preferred Instructor(if applicable):
- Session Length: *30 Minutes60 Minutes
- Preferred Instructor(if applicable):
- Session Length:30 Minutes60 Minutes
- Location: *Hammond CampusSt. Tammany CenterLivingston

Full tuition is due on or before the first lesson.

CMS STUDENTS UNDER 18

List all persons responsible for picking up the student after lessons.
- Does the student have permission to leave the Southeastern Music Building?: (If YES, then please provide the reason.) *YesNo
- For what reasons?:

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